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PubMed2003

Hand function tests and questions on hand symptoms as related to the Stockholm workshop scales for diagnosis of hand-arm vibration syndrome.

The severity of hand-arm vibration syndrome (HAVS) is usually graded according to the Stockholm workshop scales. Although the Stockholm workshop scales are regarded the gold standard for assessing the severity of HAVS, they are based primarily on subjective symptoms. The aim of the present study was to explore the agreement between Stockholm workshop scales and the outcome from ten well-defined clinical tests commonly used in hand rehabilitation for assessment of hand function. One hundred and eleven vibration-exposed workers participated in the study. Ten objective tests of hand function and four questions on subjective hand symptoms were included. The results indicated that, out of these tests, perception of vibration, perception of touch/pressure and dexterity showed a moderate agreement with Stockholm workshop scales. Among specific questions on hand symptoms, cold intolerance and pain showed a high agreement with Stockholm workshop scales. It is concluded that defined objective tests combined with directed questions on specific hand symptoms, together with the Stockholm workshop scales, may be helpful for diagnosing HAVS.

Adult↗

PubMed1995

Flexor to extensor tendon transfers in the hand.

We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up average 5.6 years (0.5-12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).

Adolescent↗

PubMed1996

Results of scaphotrapeziotrapezoid fusion for isolated idiopathic arthritis.

Scaphotrapeziotrapezoid (STT) joint fusion was carried out for pain relief in eight patients with isolated arthritis. Seven patients had satisfactory relief of symptoms. The subjective results were excellent in five, good in two and bad in one patient, who had non-union of the arthrodesis and was also the only patient to develop trapeziometacarpal arthritis. Average grip strength was 0.8 and lateral pinch strength was 0.7 of that in the other hand. There was a very small relative difference in dexterity. There was an average difference of 9 degrees of flexion-extension and 13 degrees of radio-ulnar deviation. It is concluded that for isolated idiopathic STT arthritis, fusion gives very satisfactory results with minimal complications.

Adult↗

PubMed1996

Surgical treatment of the divided flexor digitorum profundus tendon in zone 2, delayed more than 6 weeks, by tendon grafting in 50 cases.

The surgical treatment of the divided FDP tendon, more than 6 weeks old, in zone 2 is reviewed in 50 patients. The method used was the excision of the divided FDP tendon and the insertion of a thin tendon graft. There were 50 patients in this study; 36 were male and 14 female, aged from 18 to 60 years. All patients were markedly disabled because of loss of strength of the involved finger. Follow-up ranged from 1 to 25 years following tendon grafting. In 35 patients plantaris tendon was used and in 15 patients palmaris longus. Definite advantages were found in using the tendon grafting procedure; strength, dexterity, pinch and grasp were markedly improved. Functional results were evaluated by the Boyes method, with the Pulvertaft method as a secondary assessment. Among the 50 patients, 80% had excellent and good results (excellent 32%, good 48%) and 20% fair.

Adult↗

PubMed1998

The problem of assessing effective neuroprotection in experimental cerebral ischemia.

In animal models of global and focal ischemia neuroprotection is typically determined by quantifying the degree of cell loss or reduction in infarct volume shortly after the ischemic insult. These methods are unable to reliably detect more subtle forms of neuronal death and dysfunction that arise from injury to non-homogeneous cell populations (e.g. hilar and striatal neurons), or to dendrites (e.g. loss of structural proteins or decreased synaptic transmission). It is argued that this type of covert injury contributes to a wide range of functional impairments (e.g. decreased working memory, altered field potentials, loss of forelimb dexterity) that are rarely used as outcome measures in experimental studies even though they are of paramount importance clinically. The limitations of a purely histological approach in assessing neuroprotection are clearly illustrated using examples of protective drug therapies, mild hypothermia and ischemic preconditioning. An alternative strategy that incorporates behavioural, electrophysiological and histological endpoints is put forth as a more powerful method for gauging neuroprotection. The strength of this approach will be increased if these assessments are performed on the same animals. By incorporating functional measures and longer postischemic survival into their experimental protocols, investigators will increase the validity of their models and hopefully reduce the likelihood of advancing ineffective therapies into costly clinical trials.

Animals↗

PubMed2000

Self-renewal and differentiation of a novel bipotent myeloid progenitor clone in the stroma-dependent culture.

To understand regulation of myeloid development, it is necessary to obtain the myeloid progenitor cell lines with self-renewal and differentiation capacities. Because prolonged hematopoiesis occurs with the production of myeloid cells at all stages of differentiation in the Dexter-type long-term bone marrow cultures, we tried to obtain stroma-dependent myeloid progenitor cells starting from the long-term bone marrow culture. Murine cobblestone areas generated in long-term bone marrow cultures were serially passaged every 10 days. After 4 months, the resultant hematopoietic cells, designated as DFC, were passaged on a monolayer of established spleen stromal cell line, MSS62. After 10-12 passages of DFC cells on MSS62, several clones were obtained by colony formation on MSS62 cell layer. Among these clones, DFC-a cells could be maintained for a long period by coculturing with the established stromal cell line, MSS62.DFC-a cells proliferated by forming cobblestones and contained blast cells, granulocytes, and macrophages. Cell sorting and coculture experiments indicated that the blast type cells exhibiting c-Kit(+) Gr-1(-) Mac-1(-), stroma-dependently self-renewed, and spontaneously differentiated toward granulocytes (c-Kit(+) Gr-1(+) Mac-1(+)) and macrophages (c-Kit(low/+) Gr-1(-) Mac-1(high)). Although most of DFC-a cells expressed c-Kit, SCF-c-Kit interaction was not always necessary for their growth. In the presence of stromal cells, growth and differentiation of DFC-a cells were stimulated by GM-CSF or IL-3. Without stromal cells, DFC-a was transiently expanded by GM-CSF or IL-3 but could not be maintained constantly by these cytokines. The present study demonstrated that DFC-a is a novel bipotent myeloid progenitor cell clone as a simple model system of stroma-dependent myeloid development. It may reflect distinct properties for the earliest myeloid progenitor cells in vivo. It is of interest to know what signals are provided by MSS62 stromal cells to maintain the myeloid progenitor cells.

Animals↗

PubMed2000

Mesenchymal stem cells: biology and potential clinical uses.

There has been an increasing interest in recent years in the stromal cell system functioning in the support of hematopoiesis. The stromal cell system has been proposed to consist of marrow mesenchymal stem cells that are capable of self-renewal and differentiation into various connective tissue lineages. Recent efforts demonstrated that the multiple mesenchymal lineages can be clonally derived from a single mesenchymal stem cell, supporting the proposed paradigm. Dexter demonstrated in 1982 that an adherent stromal-like culture was able to support maintenance of hematopoietic stem as well as early B lymphopoeisis. Recent data from in vitro models demonstrating the essential role of stromal support in hematopoiesis shaped the view that cell-cell interactions in the marrow microenvironment are critical for normal hematopoietic function and differentiation. Maintenance of the hematopoietic stem cell population has been used to increase the efficiency of hematopoietic stem cell gene transfer. High-dose chemotherapy and frequently cause stromal damage with resulting hematopoietic defects. Data from preclinical transplantation studies suggested that stromal cell infusions not only prevent the occurrence of graft failure, but they have an immunomodulatory effect. Preclinical and early clinical safety studies are paving the way for further applications of mesenchymal stem cells in the field of transplantation with respect to hematopoietic support, immunoregulation, and graft facilitation.

Bone Marrow Cells↗

PubMed2001

The molecular basis for the cytokine-induced defect in homing and engraftment of hematopoietic stem cells.

OBJECTIVE: Hematopoietic stem cell homing and engraftment is dramatically altered by cytokine exposure. These studies address the molecular mechanisms responsible for the observed changes in transplantation biology. METHODS: Primitive murine hematopoietic stem cells were isolated by fluorescence-activated cell sorting of lineage depleted (Lin(-)) cells exhibiting low staining of Hoechst 33342 and rhodamine 123 dyes or Lin(-) cells bearing Sca. Adhesion receptor expression was examined by immunofluorescence and reverse transcriptase polymerase chain reaction. In vitro adhesion assays were employed to define binding interactions between stem cells and stroma or extracellular matrix proteins. RESULTS: Adhesion of Lin(-)Sca+ cells to Dexter stroma could be blocked by about 90% with antibodies to PECAM-1, alphaa(4), or beta(1), and partially blocked by antibodies to alpha(5), CD44, or L-selectin. By immunofluorescence, about 30% of purified Lin(-)Ho(lo)Rho(lo) cells expressed alpha(4), alpha(5), beta(1), and L-selectin, about 15% expressed alpha(L) and alpha(6), half expressed PECAM-1, and none expressed alpha(1) or alpha(2). After 48 hours in expansion cytokines, only 9% of the cells expressed alpha(4) and none expressed beta(1), whereas alpha(L) expression was fully restored, PECAM-1 and L-selectin partially restored, CD44 expression was newly induced, and adhesion to both fibronectin and laminin was reduced. Adhesion to purified collagen, fibronectin, or laminin enhanced expression of beta(1) integrins. CONCLUSION: Expansion cytokines that move quiescent primitive hematopoietic stem cells into S phase markedly altered adhesion receptor expression and reduced their functional binding to extracellular matrix, which could reduce engraftment after transplant.

Animals↗

PubMed2003

Telomerized human multipotent mesenchymal cells can differentiate into hematopoietic and cobblestone area-supporting cells.

OBJECTIVE: To compare the hematopoietic support provided by telomerized human mesenchymal stem cells (MSCs) and telomerized MSC-derived stromal cells. METHODS: We transfected the human telomerase catalytic subunit (hTERT) gene into primary MSCs to establish hTERT-transduced MSCs (hTERT-MSCs). Stromal induction of hTERT-MSCs was performed by replacing the culture medium with Dexter-type culture medium. Hematopoietic support was examined by coculture with cord blood CD34(+) cells. RESULTS: The hTERT-MSCs were morphologically identical with the primary MSCs and expressed surface antigens including CD105, CD73, and CD166. hTERT-MSCs showed a similar doubling time as primary MSCs and continued to proliferate to over 80 population doublings (PD), although the primary MSCs underwent crisis in vitro at 16 PD. The osteogenic, chondrogenic, adipogenic, neurogenic, and stromal differentiation potential of hTERT-MSCs were maintained up to at least 40 PD. The degree of expansion of CD34(+) cells and total number of colony-forming units in culture (CFU-C) upon 12-day coculture with the hTERT-MSC-derived stromal cells were nearly the same as those upon 12-day coculture with hTERT-MSCs (CD34, 33.0-fold+/-2.8-fold vs 36.1-fold+/-1.7-fold of the initial cell number; CFUs, 344.4-fold+/-62.5-fold vs 239.3-fold+/-87.0-fold; CFU-mix, 368.4-fold+/-113.7-fold vs 341.3-fold+/-234.3-fold). However, on day 18 of coculture, the number of cobblestone areas (CA) observed beneath the stromal cells was 15 times higher than that beneath hTERT-MSCs (CA, 146.9+/-54.6 vs 9.4+/-8.1, p<0.01). CONCLUSION: Stromal induction of hTERT-MSCs exclusively enhanced the support of CA formation provided by hTERT-MSCs. Our human hTERT-MSCs will be useful for elucidating the mechanism of the formation of CAs.

Adult↗

PubMed2003

Current status of robotics in urologic laparoscopy.

Urology has continuously embraced novel technologies like laparoscopy that reduce patient morbidity yet maintain an excellent standard of care. Because of limitations on maneuverability, operative vision, manual dexterity, and tactile sense, laparoscopy can be more difficult to perform than corresponding tasks in open surgery. To potentially increase clinical applicability of laparoscopy, robots that enhance operative performance have recently been introduced for a variety of laparoscopic procedures such as laparoscopic radical prostatectomy, pyeloplasty, and even laparoscopic cystectomy and neobladder construction. While these robots have generated excitement and many robotic applications have been described, the benefit of the advanced technology in expanded series of patients remains largely unknown. In addition, the ability of telerobotics to be used by surgeons inexperienced in conventional laparoscopy is also poorly understood. This review compares current features of available robots, advantages and limitations of robots, the emerging clinical applications, and the future potential of robotics in urology.

Humans↗

PubMed2003

The use of the Memokath stent in the treatment of detrusor sphincter dyssynergia in spinal cord injury patients: a single-centre seven-year experience.

AIMS: A retrospective analysis of our seven-year experience with the Memokath urethral stent for the treatment of detrusor sphincter dyssynergia (DSD) in spinal cord injured (SCI) patients. PATIENTS AND METHODS: Twenty five patients with SCI underwent rhabdosphincter Memokath stent insertion. The mean age was 45.5 years (range 32-65 years). The level of injury was cervical in 14 and thoracic in 11 patients. All patients were shown to have neurogenic detrusor overactivity with DSD associated with high detrusor pressures and incomplete emptying on pre-operative video-cystometrograms (VCMG). The Memokath stent was inserted using a standardized protocol. Follow-up assessment included blood chemistry, ultrasound scan (upper tracts and residual urine) at one and three months after insertion, and a follow-up VCMG at six months. The pre-operative and six-month post-operative VCMG results were analysed by the paired t-test and p value <0.05 was taken as significant. RESULTS: There was a significant reduction in maximum detrusor pressure, duration of contraction and residual urine volume (p<0.05) on the VCMG six months after insertion of the stent. At present six patients have a Memokath stent in situ at a mean of 34.7 months (range 6-86 months). Nineteen stents were removed for several reasons at a mean of 20.3 months (range 0.25-41 months). These include, exacerbation of autonomic dysreflexic symptoms (n=3); stent migration (n=7); encrustation and stone formation (n=5); incomplete bladder emptying without obstruction (n=3); entrance into fertility program (n=1). CONCLUSION: The Memokath stent is safe, easy and quick to insert with minimal trauma to the urethra. It is effective in the management of DSD and decreasing the detrusor pressure and residual urine volume in SCI patients. Moreover the ease of its removal in a non-traumatic fashion makes this stent an attractive option when patients are still contemplating the method of bladder management, in those wishing to be involved in fertility program and in recently SCI patients who may recover some manual dexterity to perform clean intermittent self-catheterisation. It must be remembered that this is a temporary stent, as our study clearly shows that the majority are removed within two years of insertion.

Adult↗

PubMed1989

Piso-triquetral pain syndrome after carpal tunnel release.

Hypothenar pain was a major complaint in 1.1% of patients 6 months after operation in 500 consecutive carpal tunnel releases. Pain, discomfort, and loss of grip strength was noticed mostly during activities requiring full hand grip or activities associated with use of the heel of the hand, such as pushing up from a chair, or pushing open a door with the flat palm. The pain originated from the piso-triquetral joint, possibly a result of intercarpal alignment change after carpal tunnel release. Pisiform excision was curative, with complete relief of symptoms and return of strength and dexterity. Awareness of this syndrome and systemic evaluation of the piso-triquetral joint preoperatively and postoperatively, as presented here, are essential in the management of this condition.

Adult↗

PubMed1999

Age-related changes in upper extremity performance of elderly people: a longitudinal study.

The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.

Aged↗

PubMed2002

Carpal tunnel syndrome in children.

CTS is uncommon in children. A number of conditions predispose children to developing CTS. These conditions include the lysosomal storage diseases, a multigenerational history of CTS, and macrodactyly. Because many case are idiopathic, isolated cases are possible even in the normal child or adolescent. Children with CTS often have modest complaints in spite of long-standing difficulties such as decreased manual dexterity in one hand or poorly localized pain. Physical findings tend to be dramatic abnormalities such as severe thenar weakness and atrophy. These findings suggest that many children are diagnosed late in the course of their nerve compression. Because some patients have profound atrophy at a young age, the condition can be confused with primary thenar hypoplasia. Provocative tests, the Tinel and Phalen tests, are often normal in children with long-standing nerve compression. Electrodiagnostic studies are essential to establishing the diagnosis in many children. Pediatric cases of CTS tend to demonstrate bilateral electrophysiologic abnormalities, even if only one hand is primarily involved clinically. Therefore, it is recommended that EMG and NCS be performed bilaterally in all suspected children. Sedation may be helpful in obtaining electrodiagnostic studies in a small child. Open operative release is the only treatment documented to be effective in the treatment of childhood CTS.

Adolescent↗

PubMed2003

Mutilating hand injuries: principles and management.

The objectives of the treatment of mutilating hand injuries are to insure patient's survival, limb survival and ultimately limb function. Initially, patients are stabilized and cleared of other potentially life threatening trauma. The cornerstone to the early intra-operative management of the mangled hand includes irrigation and debribement. Skeletal stabilization, revascularization, replantation or the use of spare parts to restore functions are addressed at the initial surgery. Subsequent second or third look surgeries may be required to procure a clean wound bed. Regional flaps and free tissue transfer provides definitive coverage than soft tissue is required. Secondary procedures such as tenolysis, joint mobilization or toe transfers may be needed to restore dexterity to the healed yet dysfunctional hand. Adherence to sound safe principles help prevent further mobidity while fostering the restoration of hand function to return the patient to gainful activities.

Adult↗

PubMed2003

Outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health.

This article is a brief review of the outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Several tools currently exist to quantify outcome in hand surgery at the impairment level (eg, mobility, hand strength, cutaneous sensation, dexterity). According to the World Health Organization's paradigm, however, activity limitations and participation restrictions are also clinically relevant. The authors have recently built a measure of an upper limb-impaired individual's ability to manage manual activities in daily life. Participation and quality of life are difficult outcomes to measure because they are multidimensional and depend on such factors as functional abilities, general physical health, financial security, and stability of the social and familial environment.

Activities of Daily Living↗

PubMed2003

Functional and outcome evaluation of the hand and wrist.

The first evaluation of the upper extremity and hand, performed by the surgeon at the outpatient clinic, is fundamental to understanding the patient's problem, determining the best treatment options, and, in the case of a surgical indication, assessing the preoperative status. In addition to recording the patient's symptoms and complaints, the surgeon evaluates anatomic integrity, stability, mobility, trophicity, strength, and sensibility. In many patients, especially patients with severe handicaps or those who anticipate long delays in rehabilitation, in litigation problems, or as part of prospective clinical research, this classic evaluation is not sufficient. The authors recommend that to accommodate these patients, a laboratory of functional evaluation of the hand should be established. The evaluation, performed by independent reviewers, ideally includes techniques allowing objective measurements of kinematics, strength, sensibility, and global hand function and dexterity. Pain assessment using the VAS is indispensable. The results may be presented as scores based on to the patient's problem. The researchers should analyze precisely how the scores were constructed. Questionnaires are part of the evaluation armamentarium. As with other tools, questionnaires allow us to understand better what our patients experience. They do not replace physical examination. Questionnaires also could be used for routine screening in a general upper limb practice, even before the patient sees the hand surgeon. The choice of the questionnaire is important; the reviewer should make sure that the patient understands all questions, that the questions are not redundant, and that they do apply to the patient. Generic health status instruments such as the SF-36 allow comparison across a variety of health problems, including mental and physical conditions, but are not sensitive to upper extremity disability. The DASH questionnaire seems a better choice, allowing a standardized outcome evaluation. Dedicated questionnaires have been developed for specific conditions (eg, carpal tunnel syndrome). As discussed by Amadio, questionnaires are easier to perform than physical testing, can be self-administered, and require no special equipment, saving the cost of an examiner, avoiding the complexities of scheduling a follow-up examination, and eliminating the possibility of observer bias. The patient is less likely to offer polite but incorrect responses. Questionnaires are especially useful when patient's perceptions are important to assess. Questionnaires also could be used in longitudinal studies to assess improvement or aggravation. The use of questionnaires is therefore especially indicated in studies involving a large number of patients, when observer bias and costs are concerns, and when the main outcome measurements are satisfaction, symptoms, or functional status. Amadio has pointed out that questionnaires are not the best tool to measure anatomic or physiologic impairments.

Biometry↗

PubMed2003

Brachial plexus dorsal rhizotomy in hemiplegic cerebral palsy.

Brachial plexus dorsal rhizotomy releases spasticity, improving the functional use of the hand. Grasping and pinch strength are augmented, together with movement speed and dexterity. Even when four dorsal roots have been sectioned, hand sensibility is largely preserved. Movement control is improved and equally advantageous in athetotic patients. Brachial plexus dorsal rhizotomy does not exclude the use of tendon lengthening or transfer procedures, but it is the authors' opinion that orthopedic procedures should be performed after dorsal rhizotomy. Children aged 5-6 years without muscle contractures are the ideal candidates to benefit fully from dorsal rhizotomy.

Activities of Daily Living↗